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Primasari I, Hoeboer CM, Bakker A, Olff M. Adaptation and validation study of the Indonesian version of the Global Psychotrauma Screen in an undergraduate student population. Compr Psychiatry 2024; 132:152485. [PMID: 38653061 DOI: 10.1016/j.comppsych.2024.152485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The high incidence of potentially traumatic events (PTEs) in Indonesia warrants early identification of those with probable trauma-related disorders in order to tailor prevention and intervention for trauma-related symptoms. OBJECTIVES This study aims to adapt and validate a novel brief transdiagnostic screener, the Global Psychotrauma Screen (GPS), in Indonesian undergraduate students. METHODS An online survey was administered among Indonesian undergraduate students (N = 322). Exploratory factor analysis, reliability analyses, clinical validity analyses, and correlational analyses were performed to evaluate the construct validity, reliability, clinical validity, and convergent-divergent validity of the Indonesian GPS. Hierarchical multiple regression was conducted to assess the relationship between risk factors and trauma-related symptoms. The relationship between four categories of trauma-related symptom severity and social/work functioning was measured using Analysis of Covariance. RESULTS Exploratory factor analysis yielded a single-factor solution. The Indonesian GPS demonstrated good internal consistency, test-retest correlation, and absolute agreement, indicating good reliability. The Indonesian GPS also had an acceptable area under the curve, sensitivity, and specificity for a probable diagnosis of Post-Traumatic Stress Disorder (PTSD), Complex-PTSD (CPTSD), depression, and generalized anxiety disorder (GAD). We also established evidence for the convergent and divergent validity of GPS. The GPS risk factors (low psychological resilience, other stressful events, history of mental illness, and low social support) contributed to predicting trauma-related symptoms after controlling for gender, age, employment status, and faculty background. Additionally, in comparison to participants from the mild and low categories of GPS symptoms scores, participants from the severe and moderate category reported impaired lowered social/work functioning. CONCLUSION The current findings indicate that the Indonesian GPS is a valid and reliable transdiagnostic trauma screener for Indonesian undergraduate students. This first comprehensive validation of the GPS in Indonesia calls for more research in Lower-middle Income Countries (LMICs) as a way towards prevention and early intervention for trauma-related symptoms.
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Affiliation(s)
- Indira Primasari
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; Faculty of Psychology, Universitas Indonesia, Depok, Indonesia.
| | - Chris M Hoeboer
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Anne Bakker
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; Department of Trauma Care, OLVG, Amsterdam, the Netherlands
| | - Miranda Olff
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
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2
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Sarr R, Quinton A, Spain D, Rumball F. A Systematic Review of the Assessment of ICD-11 Complex Post-Traumatic Stress Disorder (CPTSD) in Young People and Adults. Clin Psychol Psychother 2024; 31:e3012. [PMID: 38894553 DOI: 10.1002/cpp.3012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
Complex post-traumatic stress disorder (CPTSD) was introduced in the International Classification of Diseases (ICD) 11 in 2013 to simplify diagnosis and increase clinical utility. Given the recent ICD-11 conceptualisation, there is no standard approach for its assessment, and a review of research is necessary. This systematic review focuses on ICD-11 CPTSD assessment in young people aged 7 to 17 and adults aged 18 and above, examining measures, differentiating features and clinical considerations. Data from five databases are reviewed using a narrative synthesis approach and the quality of evidence is assessed and discussed. A total of 36 studies involving 5901 participants recruited from clinical settings and 1458 professionals with CPTSD assessment experience were included. Studies predominantly focused on adults, and the most used measure for assessment was the International Trauma Questionnaire. Papers focusing on differentiating features highlighted increased symptom severity, impairment and difficulties in individuals with CPTSD, compared to those with PTSD across various characteristics in both young people and adults. This review also identified the importance of a sensitive clinical approach with adaptations based on culture and age. Although gold-standard recommendations cannot be made, this paper offers tentative clinical practice recommendations and considerations regarding ICD-11 CPTSD assessment.
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Affiliation(s)
- Rachel Sarr
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alice Quinton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Debbie Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Freya Rumball
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Adult Autism Service, Oxleas NHS Foundation Trust, Dartford, UK
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Haering S, Kooistra MJ, Bourey C, Chimed-Ochir U, Doubková N, Hoeboer CM, Lathan EC, Christie H, de Haan A. Exploring transdiagnostic stress and trauma-related symptoms across the world: a latent class analysis. Eur J Psychotraumatol 2024; 15:2318190. [PMID: 38420969 PMCID: PMC10906118 DOI: 10.1080/20008066.2024.2318190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Background: Although trauma exposure is universally prevalent, the ways in which individuals respond to potentially traumatic events vary. Between-country differences have been identified as affecting the development and manifestation of transdiagnostic psychological symptoms, but it remains unclear how stress and trauma-related transdiagnostic symptoms and risk patterns differ based on geographic region.Objective: To explore whether there are distinct classes of stress and trauma-related transdiagnostic symptoms and to determine predictors of class membership in a global sample.Method: Participants (N = 8675) from 115 different countries were recruited online between 2020-2022 and completed the Global Psychotrauma Screen, which assesses stress and trauma exposure, related symptoms, and risk factors. A latent class analysis (LCA) was used to identify classes of stress and trauma-related symptoms per world region (African States, Asia-Pacific States, Eastern European States, Latin American and Caribbean States, Western European and Other States, and North America) and the total sample. Likelihood of class membership was assessed based on demographics, characteristics of the potentially traumatic event, and potential risk factors across the world regions.Results: Similar class compositions were observed across regions. A joint latent class analysis identified three classes that differed by symptom severity (i.e. high, moderate, low). Multinomial logistic regression analyses revealed several factors that conferred greater risk for experiencing higher levels of symptoms, including geographic region, gender, and lack of social support, among others.Conclusions: Stress and trauma-related symptoms seem to be similarly transdiagnostic across the world, supporting the value of a transdiagnostic assessment.
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Affiliation(s)
- Stephanie Haering
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Gender in Medicine, Charité Center for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marike J. Kooistra
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Christine Bourey
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ulziimaa Chimed-Ochir
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Nikola Doubková
- Clinical Research Program, National Institute of Mental Health, Klecany, Czech Republic
- Faculty of Education, Charles University, Prague, Czech Republic
| | - Chris M. Hoeboer
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Emma C. Lathan
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | | | - Anke de Haan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland
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4
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Grace E, Rogers R, Usher R, Rivera IM, Elbakry H, Sotilleo S, Doe R, Toribio M, Coreas N, Olff M. Psychometric properties of the Global Psychotrauma Screen in the United States. Health Psychol Behav Med 2023; 11:2266215. [PMID: 37811317 PMCID: PMC10557551 DOI: 10.1080/21642850.2023.2266215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Prior research assessing the psychometric properties of the Global Psychotrauma Screen provided support for its internal consistency reliability, construct validity, convergent validity, and divergent validity in several international samples, but not specifically in a U.S. subsample. Objective The purpose of this study was to assess psychometric properties of the GPS in the U.S. Method This observational study included a convenience sample of individually recruited participants (N = 231) who completed an initial study with 126-item online questionnaire and a two-week follow-up study with GPS alone through the weblinks provided by the research team. Data analyzes included measuring internal consistency and test-retest reliability, exploratory and confirmatory factor analyzes (EFA and CFA), convergent and divergent validity, sensitivity, specificity, and severity of the GPS symptom items. Additional CFA was conducted with data (N = 947) from the GPS multinational research project, U.S. subsample. Results The results showed acceptable internal consistency and test-retest reliability, convergent validity, and divergent validity of the GPS. The construct validity results supported a three-factor structure of the GPS symptoms. The GPS domains showed acceptable sensitivity and specificity with the cut-off scores of 3 for PTSD and 5 for CPTSD domains; and the scores of 1 for the anxiety, depression, and insomnia domains respectively. The GPS risk factors predicted the GPS symptom severity. Conclusions This study provides new and additional evidence on the psychometric properties of the GPS which may help health care providers with the selection of an appropriate screening instrument for trauma-related transdiagnostic symptoms. The study limitations should be addressed in future research through the replication of EFA and CFA internationally with larger samples, and the inclusion of a reference standard for dissociation.
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Affiliation(s)
- Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Rosalind Rogers
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Robin Usher
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Iris Margarita Rivera
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Hanan Elbakry
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Shanelle Sotilleo
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Renee Doe
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Mariella Toribio
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Narda Coreas
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
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5
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Havermans DCD, Hoeboer CM, Sobczak S, Primasari I, Coimbra BM, Hovnanyan A, Novakovic IZ, Langevin R, Aakvaag HF, Grace E, Dragan M, Lueger-Schuster B, El-Hage W, Olff M. The mental health impact of the COVID-19 pandemic and exposure to other potentially traumatic events up to old age. J Trauma Stress 2023; 36:738-749. [PMID: 37218466 DOI: 10.1002/jts.22937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 05/24/2023]
Abstract
We investigated whether the impact of potentially traumatic events (PTEs) on trauma-related symptoms changes across the transitional adult lifespan (i.e., 16-100 years old) and if this association differs for self-reported COVID-19-related PTEs compared to other PTEs. A web-based cross-sectional study was conducted among 7,034 participants from 88 countries between late April and October 2020. Participants completed the Global Psychotrauma Screen (GPS), a self-report questionnaire assessing trauma-related symptoms. Data were analyzed using linear and logistic regression analyses and general linear models. We found that older age was associated with lower GPS total symptom scores, B = -0.02, p < .001; this association remained significant but was substantially weaker for self-reported COVID-19-related PTEs compared to other PTEs, B = 0.02, p = .009. The results suggest an association between older age and lower ratings of trauma-related symptoms on the GPS, indicating a blunted symptom presentation. This age-related trend was smaller for self-reported COVID-19-related PTEs compared to other PTEs, reflecting the relatively higher impact of the COVID-19 pandemic on older adults.
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Affiliation(s)
- Demi C D Havermans
- School for Mental Health and Neuroscience (MHeNs), Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- TanteLouise, Bergen op Zoom, The Netherlands
| | - Chris M Hoeboer
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Sjacko Sobczak
- School for Mental Health and Neuroscience (MHeNs), Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Mondriaan Mental Health Center, Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen, Maastricht, The Netherlands
| | - Indira Primasari
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
- Faculty of Psychology, Universitas Indonesia, Depok, Indonesia
| | - Bruno M Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ani Hovnanyan
- Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - Irina Zrnic Novakovic
- Lab for Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Austria
| | - Rachel Langevin
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, Canada
| | - Helene F Aakvaag
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, District of Columbia, USA
| | | | - Brigitte Lueger-Schuster
- Lab for Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Austria
| | - Wissam El-Hage
- UMR 1253, IBrain, Université de Tours, Inserm, Tours, France
| | - Miranda Olff
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
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Salimi Y, Hoeboer C, Motevalli Haghi SA, Williamson RE, Rahimi MD, Rajabi-Gilan N, Almasi A, Olff M. Trauma and its consequences in Iran: cross-cultural adaption and validation of the Global Psychotrauma Screen in a representative sample. BMC Psychiatry 2023; 23:65. [PMID: 36694179 PMCID: PMC9873548 DOI: 10.1186/s12888-023-04564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Potentially traumatic events may lead to the development of a wide range of adverse psychological responses, including symptoms of anxiety, depression, and (complex) posttraumatic stress disorder (PTSD). Despite the high prevalence of potentially traumatic events in Iran, there is no population data nor evidence-based instrument to screen for cross-diagnostic psychological responses to trauma. The Global Psychotrauma Screen (GPS) is a transdiagnostic self-report instrument for the detection of trauma-related symptoms, as well as risk and protective factors related to the impact of potentially traumatic events. OBJECTIVE The present study seeks to 1) translate and cross-culturally adapt the GPS in the Persian (Farsi) language and 2) examine the psychometric properties of the Persian GPS. METHOD The translation and adaptation were performed using the Sousa and Rojjanasrirat (2011) method. A pilot study (n = 30) was carried out to test the content validity and test-retest reliability of the GPS. Next, in a representative sample (n = 800) of residents of Kermanshah City, the GPS, the General Health Questionnaire (GHQ) and the PTSD Checklist for DSM-5 (PCL-5) were administered. Construct validity of the Persian GPS was assessed using exploratory and confirmatory factor analysis. Additionally, we evaluated the convergent validity and internal consistency of the GPS. RESULTS Exploratory and confirmatory factor analyses indicated a three-factor model as the best solution with factors representing 1) Negative Affect, 2) Core PTSD symptoms and 3) Dissociative symptoms. The GPS total symptom score had high internal consistency and high convergent validity with related measures. A GPS total symptom cut-off score of nine was optimal for indicating a probable PTSD diagnosis based on the PCL-5. About half (52%) of the current sample met criteria for probable PTSD. CONCLUSIONS The current findings suggest that the GPS can be effectively adapted for use in a non-Western society and, specifically, that the Persian GPS represents a useful, reliable and valid tool for screening of trauma-related symptoms in Iran.
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Affiliation(s)
- Yahya Salimi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - C. Hoeboer
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Seyed Ali Motevalli Haghi
- grid.5608.b0000 0004 1757 3470Cognitive Neuroscience and Clinical Neuropsychology, Department of General Psychology, University of Padova, Padua, Italy
| | - R. E. Williamson
- grid.253613.00000 0001 2192 5772Department of Psychology, University of Montana, Missoula, MT USA
| | - Mohammad Dawood Rahimi
- grid.411301.60000 0001 0666 1211Cognitive Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Nader Rajabi-Gilan
- grid.412112.50000 0001 2012 5829Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran ,grid.411189.40000 0000 9352 9878Sociology Department, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
| | - Ali Almasi
- grid.412112.50000 0001 2012 5829Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - M. Olff
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
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Hoffman J, Ben-Zion Z, Arévalo A, Duek O, Greene T, Hall BJ, Harpaz-Rotem I, Liddell B, Locher C, Morina N, Nickerson A, Pfaltz MC, Schick M, Schnyder U, Seedat S, Shatri F, Sit HF, von Känel R, Spiller TR. Mapping the availability of translated versions of posttraumatic stress disorder screening questionnaires for adults: A scoping review. Eur J Psychotraumatol 2022; 13:2143019. [PMID: 38872602 PMCID: PMC9724641 DOI: 10.1080/20008066.2022.2143019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background: The most used questionnaires for PTSD screening in adults were developed in English. Although many of these questionnaires were translated into other languages, the procedures used to translate them and to evaluate their reliability and validity have not been consistently documented. This comprehensive scoping review aimed to compile the currently available translated and evaluated questionnaires used for PTSD screening, and highlight important gaps in the literature.Objective: This review aimed to map the availability of translated and evaluated screening questionnaires for posttraumatic stress disorder (PTSD) for adults.Methods: All peer-reviewed studies in which a PTSD screening questionnaire for adults was translated, and which reported at least one result of a qualitative and /or quantitative evaluation procedure were included. The literature was searched using Embase, MEDLINE, and APA PsycInfo, citation searches and contributions from study team members. There were no restrictions regarding the target languages of the translations. Data on the translation procedure, the qualitative evaluation, the quantitative evaluation (dimensionality of the questionnaire, reliability, and performance), and open access were extracted.Results: A total of 866 studies were screened, of which 126 were included. Collectively, 128 translations of 12 different questionnaires were found. Out of these, 105 (83.3%) studies used a forward and backward translation procedure, 120 (95.2%) assessed the reliability of the translated questionnaire, 60 (47.6%) the dimensionality, 49 (38.9%) the performance, and 42 (33.3%) used qualitative evaluation procedures. Thirty-four questionnaires (27.0%) were either freely available or accessible on request.Conclusions: The analyses conducted and the description of the methods and results varied substantially, making a quality assessment impractical. Translations into languages spoken in middle- or low-income countries were underrepresented. In addition, only a small proportion of all translated questionnaires were available. Given the need for freely accessible translations, an online repository was developed.HIGHLIGHTS We mapped the availability of translated PTSD screening questionnaires.The quality of the translation and validation processes is very heterogenous.We created a repository for translated, validated PTSD screening questionnaires.
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Affiliation(s)
- Joel Hoffman
- School of Psychology, UNSW Australia, Sydney, Australia
| | - Ziv Ben-Zion
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | - Adrián Arévalo
- Facultad de Medicina & Neuron Research Group Lima, Universidad de Piura, Lima, Perú
- Facultad de Medicina "San Fernando", Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Brian J Hall
- Center for Global Health equity, New York University (Shanghai), Shanghai, People's Republic of China
- School of Global Public Health, New York University, New York, NY, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | | | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Monique C Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fatlinda Shatri
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hao Fong Sit
- Department of Psychology, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Pinto JV, Hunt C, O'Toole B. Advancing PTSD Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Non-Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38223. [PMID: 35596546 PMCID: PMC9244657 DOI: 10.2196/38223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Decentralized health systems in Low and Middle-Income Countries (LMICs) impacted by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Innovative approaches that are safe, cost-effective, and scalable are needed to address the burden of traumatic stress brought by emergencies. High mobile phone ownership rates combined with the precision of neural, cognitive, and biometric measures of trauma and its feasible integration with Artificial Intelligence (AI) makes digital application (app) interventions a promising pathway to promote precision diagnosis and high-impact care. OBJECTIVE The aims of this study are to advance methods for the objective diagnosis and treatment of trauma in emergencies across LMICs by examining (i) neural, cognitive, and biometric markers and (ii) the efficacy of the eResilience App, a neuroscience-informed mobile health mental health app intervention, via changes in clinical symptomatology, cognitive performance, and brain activity. METHODS Trauma-exposed African refugees residing in Australia were selected for this study. A research software version of the eResilience App with advanced monitoring capabilities was designed for the trial. Participants completed the eResilience App at home during a seven-day period. Clinical, cognitive, and electrophysiological data were collected during baseline and post-test to examine biomarkers of trauma and the efficacy of the proposed digital intervention for the treatment of trauma and its potential outcomes including depression, anxiety, physical symptoms, self-harm, substance misuse, and cognitive impairment. In addition, biofeedback, wellbeing, and subjective stress data points were collected via the app during the treatment week, followed by clinical interviews at 1, 3, 6 and 12-months post-intervention. RESULTS Data collection was conducted between 2018 and 2020. A total n=100 participants exposed to war were screened, n= 75 were enrolled and assigned to a trauma-exposed control (n=38) or Posttraumatic Stress Disorder (PTSD) condition (n=37), and n= 70 completed all baseline, treatment, and post-test assessments. A total n=62 of the n=70 who completed the intervention opted to enrol in the 3, 6 and 12-month follow-ups. Data collection is complete, and results are being prepared for publication. If proven efficacious, this proof-of-concept clinical trial will inform fully powered randomized clinical trials in LMICs to further develop AI-powered, app-based diagnostic and prognostic features, and determine the app's cross-cultural efficacy for the treatment of trauma in emergency settings. CONCLUSIONS This protocol provides researchers with a comprehensive background of the study rationale, a detailed guideline for replication studies interested in examining the feasibility and the efficacy of the eResilience App across varied demographics, and a robust framework for investigations of low-cost objective diagnostic markers in mental health interventions. Methodological limitations and suggestions are also provided. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001205426. Universal Trial Number (UTN): U1111-1180-0347.
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Affiliation(s)
- Janaina Videira Pinto
- Faculty of Medicine and Health, the University of Sydney, 94 Mallett St, Sydney, AU.,Sync Body-Brain Health, Currimundi, AU
| | - Caroline Hunt
- School of Psychology, Faculty of Science, the University of Sydney, Sydney, AU
| | - Brian O'Toole
- Faculty of Medicine and Health, the University of Sydney, 94 Mallett St, Sydney, AU
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9
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Williamson RE, Hoeboer CM, Primasari I, Qing Y, Coimbra BM, Hovnanyan A, Grace E, Olff M. Symptom networks of COVID-19-related versus other potentially traumatic events in a global sample. J Anxiety Disord 2021; 84:102476. [PMID: 34560583 PMCID: PMC8423664 DOI: 10.1016/j.janxdis.2021.102476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
The potential mental health consequences of the coronavirus disease 2019 (COVID-19) pandemic are widely acknowledged; however, limited research exists regarding the nature and patterns of stress responses to COVID-19-related potentially traumatic events (PTEs) and the convergence/divergence with responses to other (non-COVID-19-related) PTEs. Network analysis can provide a useful method for evaluating and comparing these symptom structures. The present study includes 7034 participants from 86 countries who reported on mental health symptoms associated with either a COVID-19-related PTE (n = 1838) or other PTE (n = 5196). Using network analysis, we compared the centrality and connections of symptoms within and between each group. Overall, results show that the COVID-19-related network includes transdiagnostic symptom associations similar to networks tied to PTEs unrelated to the pandemic. Findings provide evidence for a shared centrality of depression across networks and theoretically consistent connections between symptoms. Network differences included stronger connections between avoidance-derealization and hypervigilance-depression in the COVID-19 network. Present findings support the conceptualization of psychological responses to pandemic-related PTEs as a network of highly interconnected symptoms and support the use of a transdiagnostic approach to the assessment and treatment of mental health challenges related to the COVID-19 pandemic.
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Affiliation(s)
- Rachel E. Williamson
- University of Montana, Missoula, Montana, United States,Correspondence to: University of Montana, Department of Psychology, 32 Campus Drive, Missoula, Montana, 59812
| | - Chris M. Hoeboer
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Indira Primasari
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands,Department of Clinical Psychology, Faculty of Psychology, Universitas Indonesia, Indonesia
| | - Yulan Qing
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Bruno M. Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ani Hovnanyan
- Department of Developmental Psychology and Socialisation, University of Padua (Università degli Studi di Padova, UNIPD), Italy
| | - Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, United States
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands,ARQ National Psychotrauma Centre, Diemen, The Netherlands
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10
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Frewen P, McPhail I, Schnyder U, Oe M, Olff M. Global Psychotrauma Screen (GPS): psychometric properties in two Internet-based studies. Eur J Psychotraumatol 2021; 12:1881725. [PMID: 34992750 PMCID: PMC8725737 DOI: 10.1080/20008198.2021.1881725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Potentially traumatic stressors can lead to various transdiagnostic outcomes beyond PTSD alone but no brief screening tools exist for measuring posttraumatic responses in a transdiagnostic manner. Objective: Assess the psychometric characteristics of a new 22-item transdiagnostic screening measure, the Global Psychotrauma Screen (GPS). Method: An internet survey was administered with English speaking participants recruited passively via the website of the Global Collaboration on Traumatic Stress (GC-TS) (nGC-TS = 1,268) and actively via Amazon's MTurk (nMTurk = 1,378). Exploratory factor analysis, correlational analysis, sensitivity and specificity analysis, and comparisons in response between the two samples and between male and female respondents were conducted. Results: Exploratory factor analysis revealed a single factor underlying symptom endorsements in both samples, suggesting that such problems may form a unitary transdiagnostic, posttraumatic outcome. Convergent validity of the GPS symptom and risk factors was established with measures of PTSD and dissociative symptoms in the MTurk sample. Gender differences were seen primarily at the item level with women more often endorsing several symptoms and specific risk factors in the MTurk sample, and the GC-TS recruited sample endorsed more symptoms and risk factors than the MTurk sample, suggesting that the GPS may be sensitive to group differences. A GPS symptom cut-off score of 8 identified optimized sensitivity and specificity relative to probable PTSD based on PCL-5 scores. Conclusions: The current results provide preliminary support for the validity of the GPS as a screener for the concurrent measurement of several transdiagnostic outcomes of potentially traumatic stressors and the apparent unifactorial structure of such symptoms is suggestive of a single or unitary posttraumatic outcome. Future research is needed to evaluate whether similarly strong psychometric properties can be yielded in response to completion of the GPS in other languages.
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Affiliation(s)
- Paul Frewen
- Departments of Psychiatry & Psychology, Western University, London, Canada
| | - Ian McPhail
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - Ulrich Schnyder
- Department of Psychiatry & Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Misari Oe
- Department of Neuropsychiatry, Kurume University, Kurume, Japan
| | - Miranda Olff
- Department of Psychiatry, University Medical Center, Amsterdam, The Netherlands
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11
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Grace E, Sotilleo S, Rogers R, Doe R, Olff M. Semantic adaptation of the Global Psychotrauma Screen for children and adolescents in the United States. Eur J Psychotraumatol 2021; 12:1911080. [PMID: 34104348 PMCID: PMC8168728 DOI: 10.1080/20008198.2021.1911080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The review of trauma screening tools for children and adolescents indicates a need for developmentally and linguistically appropriate, globally applicable, free, and easily accessible trauma screening instruments. Objective: The aim of this study is to adapt the Global Psychotrauma Screen (GPS) for children and adolescents in the United States. Method: Using the modified Delphi method, this study included the GPS Expert Consensus (GPS-EC) and the GPS Stakeholder Consensus (GPS-SC) substudies. In the GPS-EC, ten reviewers who specialize in trauma services independently revised the GPS child and adolescent versions in four rounds. In the GPS-SC, a stratified minimum sample of children and adolescents (n = 24) and their parents (n = 24) were interviewed to collect feedback on the revised GPS versions. Results: In the GPS-EC Round 1, a low level of consensus was observed on the anxiety (restlessness) and depression (loss of interest) items. In Round 2, a high level of consensus was achieved on all but PTSD hypervigilance and detachment, and CPTSD self-concept items. Round 3 indicated a low level of consensus on the exposure and functioning items. Full consensus was achieved in Round 4 on all items. In the GPS-SC, children had more difficulties than adolescents with the exposure, dissociation, and risk-protection items. Conclusions: Based on the results of this study, the semantic adaptation process concluded with implementation of six decisions on the final GPS versions for children and adolescents: adding a non-binary gender choice for adolescents; removing the exposure section; using a full-sentence structure for children and a phrase structure for adolescents; retaining the two-part items on PTSD intrusion and avoidance, retaining self-blame but removing other-blame in the PTSD-blame item; providing specific descriptions of depersonalization and derealization in the dissociation items; and removing risk-protection and functioning items for children.
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Affiliation(s)
- Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Shanelle Sotilleo
- International Psychology Ph.D. Program, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Rosalind Rogers
- International Psychology Ph.D. Program, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Renee Doe
- International Psychology Ph.D. Program, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
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12
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Rossi R, Socci V, Talevi D, Niolu C, Pacitti F, Di Marco A, Rossi A, Siracusano A, Di Lorenzo G, Olff M. Trauma-spectrum symptoms among the Italian general population in the time of the COVID-19 outbreak. Eur J Psychotraumatol 2021; 12:1855888. [PMID: 34992741 PMCID: PMC8725681 DOI: 10.1080/20008198.2020.1855888] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Recent evidence showed adverse mental health outcomes associated with the COVID-19 pandemic, including trauma-related symptoms. The Global Psychotrauma Screen (GPS) is a brief instrument designed to assess a broad range of trauma-related symptoms with no available validation in the Italian population. Aims: This study aimed to examine the factor structure of the Italian version of the GPS in a general population sample exposed to the COVID-19 pandemic and to evaluate trauma-related symptoms in the context of COVID-19 related risk factors associated with lockdown measures. Methods: We conducted a cross-sectional web-based observational study as part of a long-term monitoring programme of mental health outcomes in the general population. Eighteen thousand one hundred forty-seven participants completed a self-report online questionnaire to collect key demographic data and evaluate trauma-related symptoms using the GPS, PHQ-9, GAD-7, ISI, and PSS. Validation analyses included both exploratory and confirmatory factor analysis and correlation analyses. The relation with putative COVID-19 related risk factors was explored by multivariate regression analysis. Results: Exploratory factor analyses supported a two-factor model. Confirmatory factor analysis showed that the best fitting model was a three-factor solution, with core Post-traumatic Stress Symptoms (PTSS) (re-experiencing, avoidance, hyperarousal), Negative Affect (symptoms of depressed mood, anxiety, irritability), and Dissociative symptoms. GPS Risk factors and specific COVID-19 related stressful events were associated with GPS total and the three factor scores. Conclusions: Our data suggest that a wide range of trauma-spectrum symptoms were reported by a large Italian sample during the COVID-19 pandemic. The GPS symptoms clustered best in three factors: Negative Affect symptoms, Core PTSS, and Dissociative symptoms. In particular, high rates of core PTSS and negative affect symptoms were associated with the COVID-19 pandemic in Italy and should be routinely assessed in clinical practice.
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Affiliation(s)
- Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Dalila Talevi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antinisca Di Marco
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
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13
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Olff M, Primasari I, Qing Y, Coimbra BM, Hovnanyan A, Grace E, Williamson RE, Hoeboer CM. Mental health responses to COVID-19 around the world. Eur J Psychotraumatol 2021; 12:1929754. [PMID: 34262666 PMCID: PMC8253206 DOI: 10.1080/20008198.2021.1929754] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide. Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors, to identify the effect of COVID-19 country impact on mental health, and to evaluate regional differences in psychological responses to COVID-19 compared to other stressful events. Method: 7034 respondents (74% female) participated in the worldwide Global Psychotrauma Screen - Cross-Cultural responses to COVID-19 study (GPS-CCC), reporting on mental health symptoms related to COVID-19 (n = 1838) or other stressful events (n = 5196) from April to November 2020. Results: Events related to COVID-19 were associated with more mental health symptoms compared to other stressful events, especially symptoms of PTSD, anxiety, depression, insomnia, and dissociation. Lack of social support, psychiatric history, childhood trauma, additional stressful events in the past month, and low resilience predicted more mental health problems for COVID-19 and other stressful events. Higher COVID-19 country impact was associated with increased mental health impact of both COVID-19 and other stressful events. Analysis of differences across geographic regions revealed that in Latin America more mental health symptoms were reported for COVID-19 related events versus other stressful events, while the opposite pattern was seen in North America. Conclusions: The mental health impact of COVID-19-related stressors covers a wide range of symptoms and is more severe than that of other stressful events. This difference was especially apparent in Latin America. The findings underscore the need for global screening for a wide range of mental health problems as part of a public health approach, allowing for targeted prevention and intervention programs.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Indira Primasari
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Clinical Psychology, Faculty of Psychology, Universitas Indonesia, Depok, Indonesia
| | - Yulan Qing
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Bruno M Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ani Hovnanyan
- Department of Developmental Psychology and Socialisation, University of Padua (Università degli Studi di Padova, UNIPD), Padua, Italy
| | - Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Rachel E Williamson
- School of Community Service, St. Lawrence College, Kingston, Ontario, Canada
| | - Chris M Hoeboer
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
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